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Abstract

Background: Aortic stenosis (AS) is a common valvulopathy in octogenarians. Previous studies have shown that aortic valve replacement (AVR) is frequently not performed in this patients (pts). The aim of the present study was to investigate the incidence and prognostic impact of surgery denial or refusal in octagenerians with severe symptomatic AS.

Methods: Between 2004 and 2007, 130 pts >80 years (mean age 85±4 years, 41% males) were identified as having severe symptomatic AS in the echolab database (valve area ≤1 cm2, V max ≥4 m/s). Pts with a survival likelihood of <1 year due to noncardiac co-morbidities were excluded (n=19). Among the 94 remaining pts, 50 underwent AVR within 3 months of the index echo, whereas 44 refused or were denied surgery because of personal reasons or physician preference.

Results: In pts undergoing AVR, 30-day mortality was 10%. The overall 3-year survival of AVR pts was similar to that of the age and gender-matched general Belgian population and was significantly better than in conservatively treated pts (73 vs 21%, logrank p<0.001, Figure⇓). Among all clinical and echo variables analyzed, Cox’s regression analysis identied AVR as the only independent parameter (HR 0.19 [0.09– 0.41]; p<.0001) associated with survival.

Conclusion: Approximately 4 out of 10 octogenrians with severe symptomatic AS refuse or are denied AVR for reasons mostly related to the fear of undergoing open heart surgery. This results in an extremely poor outcome, 80% of these pts dying within the next 3 years. By contrast, AVR can be performed at acceptable risks and restores an almost normal life expectancy. Elevated age should therefore not be a reason for withholding AVR in severe AS.